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Therapie der einseitigen Stimmlippenparese

Therapy for unilateral vocal fold palsy

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Zusammenfassung

Das Leitsymptom der einseitigen Stimmlippenparese ist eine Heiserkeit, die den Patienten je nach Ausmaß und individueller Situation erheblich beeinträchtigen kann. Ziel der Therapie ist die Wiederherstellung einer klangvollen und belastbaren Stimme. Dies wird durch Verbesserung des Glottisschlusses und der Synchronisation der Stimmlippenschwingungen während der Phonation erreicht. Zu den konservativen Maßnahmen zählt vor allem die Stimmtherapie, die durch phonationssynchrone Reizstrombehandlung oder andere physikalische Verfahren unterstützt werden kann.

Bei den operativen Therapieformen unterscheidet man zwischen endoskopischen Augmentationstechniken durch Injektion von verschiedenen Materialien in die Stimmlippe und der transkutanen „framework surgery“, der Verlagerung der gelähmten Stimmlippe nach medial. Zur Injektion eignen sich gewebeverträgliche Materialien, deren Menge und Platzierung gut steuerbar sind. Die unausweichliche Resorption vieler Materialien führt allerdings zum Nachlassen der Stimmqualität, und die Veränderung der Stimmlippenmorphologie behindert die regelrechte Schwingungsfähigkeit. Die Medialisierung einer Stimmlippe hingegen ist dauerhaft, wenn auch reversibel, und mit einer geringen Komplikationsrate beim erfahrenen Operateur behaftet.

Abstract

The main symptom of unilateral vocal fold palsy is hoarseness, which can cause considerable disturbance to the patient depending on its extent and the patient’s individual situation. Therapy aims at the restitution of a tuneful and resilient voice, which can be achieved by surgical or conservative means, improving the glottal closure and synchronizing the vocal fold vibrations during phonation. Vocal therapy is a common conservative method that may be supported by psychotherapeutic or physical procedures. In surgical therapy, there is a distinction between techniques of endoscopic augmentation by injecting different materials into the vocal folds and transcutaneous laryngeal framework surgery, i.e., transferring the paralyzed vocal fold to the glottal midline. Particularly apt for injection are biocompatible materials amount and position whose can easily be controlled. However, the inevitable resorption of many materials causes deterioration in voice quality. Furthermore, the change of vocal fold morphology obstructs regular phonatory vibration. On the other hand, medialization thyroplasty leads to permanent voice amelioration without a substantial complication rate when performed by experienced surgeons.

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Schuster, M., Eysholdt, U. Therapie der einseitigen Stimmlippenparese. HNO 53, 756–765 (2005). https://doi.org/10.1007/s00106-005-1297-z

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